Insured Americans spent more on medical services in 2013 but utilized them less

October 30, 2014

Americans in 2013 spent a little more on medical services from the prior year, but utilized them less, according to a new report by the Health Care Cost Institute (HCCI).

Americans in 2013 spent a slightly more on medical services than the prior year but utilized them less, according to a new report by the Health Care Cost Institute (HCCI).

The report looked at claims data for nearly 40 million Americans aged 65 and younger who were covered by employer-sponsored health insurance (ESI).  Data was provided by three of the nation’s largest health insurers and spanned 2011 to 2013, after passage of the Affordable Care Act (ACA) and prior to the opening of health insurance exchanges.  

Spending averaged $4,864 per enrollee in 2013, up $183 - or 3.9% - from 2012. The higher spending was attributed to the rising prices of medical services and brand prescriptions.

“Price growth for medical services and brand-name drugs remained strong in 2013,” said HCCI Executive Director David Newman. “Health spending grew moderately, but that was only because consumers used fewer services.” The report also found that consumers spent an average of $800 per person out-of-pocket-a 4% increase over 2012.

One group that didn’t experience that rise in out-of-pocket costs was women aged 19-25. The study attributes the flat rate of growth to a provision of the ACA that went into effect in 2013 requiring hormone contraceptives to be covered without cost sharing.

“This is the first time we have seen flat out-of-pocket spending growth by any group of the privately insured,” said HCCI Senior Researcher Amanda Frost.

READ: Firms passing higher healthcare costs from ACA on to employees and limiting plan eligibility

Use of inpatient and outpatient services fell, while use of professional services rose 0.8%.

Medical service use fell for acute inpatient admissions, outpatient visits, primary care visits, and outpatient-other services. Driving those numbers were declines in outpatient surgery and emergency department visits, according to the study. Meanwhile, there was a rise in use of common services such as office visits to specialists and laboratory and pathology services.

Use of brand prescriptions fell by 15.5%, while the use of generic prescriptions grew by 4.5%. Generics accounted for 83.3% of prescriptions filled in 2013.

Antidepressants dominated generic prescription drug use, accounting for more than 10% of all generic drugs used in 2013.

Per-capita spending in 2013 increased across all service categories, with professional procedures accounting for 34%, acute inpatient admissions for 20% of expenditures, and outpatient services and prescriptions 28% and 17% of expenditures, respectively.

Spending per capita in 2013 was more than $1,000 higher for women than for men ($5,403 versus $4,305), consistent with prior years.

For the third consecutive year, the Northeast had the highest regional per capita expenditures ($5,037) and the fastest spending growth (4.8%).